Principles of Skin Therapy
- Deliver drug to target site in the skin by topical application, thus minimizes systemic side effects
- Mainstay of dermatologic therapy
What are the common ingredients in a topical formulation?
- Active drug(s)
- Vehicle (cream, ointment, lotion etc.)
- +/- preservatives
- +/- penetration enhancers (e.g. azone, DMSO)
- Others (e.g. antioxidants, fragrances, coloring/flavouring agents)
Potency Low |
Topical Steroid Hydrocortisone 1 – 2.5% Desonide 0.05% (Tridesilon) |
| Mid | Betamethasone valerate 0.1% (Betnovate, Celestoderm) Clobetasone butyrate 0.05% (Eumovate) Fluocinolone acetonide 0.025% or 0.01% (Synalar, Synamol) Hydrocortisone valerate 0.2% (Westcort) Mometasone furoate 0.1% (Elocom) Triamcinolone acetonide 0.1% (Aristocort, Kenalog) |
| High | Desoximetasone 0.25% (Topicort) Fluocinonide 0.05% (Lidex, Lidermol) Halcinonide 0.1% (Halog) |
Super High |
Betamethasone dipropionate 0.05% (Diprolene) Clobetasol propionate 0.5% (Dermovate) Halobetasol propionate 0.05% (Ultravate) |
Steroid Side Effect: Steroid Atrophy
Steroid Side Effect: Glaucoma from Topical Steroid
Steroid Side Effect: Striae
Steroid Side Effect: Acne
Risks of topical steroids:
- Atrophy, striae
- Telangiectasia, purpura
- Perioral dermatitis, rosacea
- Masking of initial lesion
- Tachyphylaxis or rebound
- Pigmentation abnormalities
- Systemic absorption (uncommon)
Minimizing risks:
- Avoid high potency steroids on flexures, face or genitals
- Avoid high potency steroids in children
- Avoid use of occlusion for long periods
- Be cautious when using steroids on face
